Cardiovascular Health 2026

#143

New review on the heart effects of controversial food.

  • Good: seed oils (causal), seafood (noncausal)
  • Bad: beef tallow (causal), UPF (causal), artificial sweeteners (non-causal)
  • Unclear: full-fat milk (noncausal), MCT oils (causal), stevia (nothing!)

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https://www.jacc.org/doi/10.1016/j.jacadv.2026.102591

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#144

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https://x.com/AviBittMD/status/2029983417945735599#m

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Is everyone happy now? LDL-C/ApoB causally increases the risk of ASCVD. Lowering LDL-C/ApoB causally reduces the risk of ASCVD in a cumulative way. Lower it enough and ASCVD process as we’re traditionally familiar with can’t occur.

Just because the risk isn’t 100% from high lipids for ASCVD diagnosis doesn’t mean it isn’t causal. And we can monitor the disease with CLEERLY or CAC scores.

The amount of mental gymnastics required to get around these facts is significant. The question is why not move on and accept it and focus on other things. Is LLT (lipid lowering treatment) including diet and drugs such a boogeyman?

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#145

:microphone:
20 chars

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#146

Wish one could change it to be 3-5 to 10 decades of risk and not just 10 year risk.

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#147

This is a better calculator, IMO:

https://qrisk.org/lifetime/index.php

It lets you do a “what if” scenario, where you enter current and “what if” cholesterol levels, changes in weight etc.

But most important, it’s a lifetime calculator, not a 10 year calculator. For the example you showed, the person is only 50 years old, so even with horrible numbers the chance of dying in 10 years is moderate. That underestimates the lifetime benefits from early statin intervention.

Agreed. And a lot of heart disease now is not the traditional ASCVD, because we’re getting pretty good at reducing lipoproteins and blood pressure. A common cause nowadays is “HFpEF” (heart failure with preserved ejection fraction) which most experts are considering as a form of metabolic disease. Stress seems to be a major factor.

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#148

QRISK3-lifetime :wink:

#149

Much better. But still capped at 99 years - and some of us targeting more than that :slight_smile:

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#150

I just measured my LDL in HK and it came back at 48. I’m pleased as this was using Atorvastatin 5 mg EOD. The next time I check will be with pitavastatin 2 mg daily. I’m curious as to how low it will go!

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#151

So you restarted statins? At that dose do you have any side effects? I cannot tolerate statins (tried many times), now just started Repatha which gave me immediate allergic reaction. Not sure if going to continue it.

#152

I started pitavastatin and there are no side effects! I only realized I had side effects on Atorvastatin 5 mg EOD when I switched to Pitavastatin and some muscle aches went away.

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#153

What about bemp acid and ezedimibe, do you still take or stop and if so why?

#154

This is the second age discrimination calculator that I have run into, in addition to Marek not allowing anyone born before 1945 to enter their age. :face_with_raised_eyebrow:

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#155

This is my favorite lifetime calculator which also incorporates lp(a)

https://www.lpaclinicalguidance.com/

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#156

When you say muscle aches, is that actually aches or muscle cramps?
( I was having severe cramping on statins - wondering if I should try Pitavastatin).

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#157

Yes, I still take Bempedoiic Acid and Ezetemibe. They have never caused me any problems and are a permanent part of my stack.

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#158

The best way I can describe the muscle aches are like how you feel after climbing a flight of steps. Your muscles are a bit achy. Now just imagine that feeling as a constant throughout the day. On Rosuvastatin, I felt like I was an 80 year old the aches were so bad.

A cramp, for me, is a short duration intense pain which this is not.

I found a large Chinese Pharma company just across the border in Shenzhen that makes Pitavastatin at Indian prices so I go there to buy it. They also sell brand name Dapagliflozin from Astra Zeneca at half the cost of India, so I purchase that in Shenzhen too. That’s two major drugs I no longer need to source! And they don’t require prescriptions. Too bad they don’t carry anything else I’m interested in.

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#159

Same here. Been on pita 2mg daily for last 6 months and I don’t think I have experienced any side effects.

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#160

Well, I would consider it flattering that the calculator isn’t validated for people your age! It probably means they didn’t have enough sample size to work with :slight_smile:

#161

Or terrifying. Signal to start making funeral arrangements?

#162

Don’t rely just on CAC scoring for cardiovascular health:

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